Treating Autism Today: Lacanian Perspectives - Clinical Wisdom and Contemporary Understanding

Overview: Autism as Subjective Position Versus Neurological Deficit

This revolutionary collection challenges mainstream behavioral approaches to Autism by presenting Lacanian psychoanalysis as a fundamentally different way of understanding and working with Autistic individuals. Rather than viewing Autism Spectrum Disorder as a Neurological deficit requiring correction through behavioral protocols like ABA, the authors argue that autism represents a subjective protective position—a radical defensive stance against a world experienced as “tremendously hostile.”

From this perspective, autistic symptoms including Stereotypies, echolalia, and repetitive behaviors are not random dysfunctions but meaningful productions through which Autistic subjects attempt to stabilize and control their overwhelming experience. The task of treatment is not to eliminate these behaviors but to understand their logic and help the subject construct alternative ways of relating while respecting these primary defenses.

The book critiques the contemporary rush to attribute autism exclusively to neurobiology, noting that despite decades of research funding, “it has proven impossible to establish a simple causal relationship between genetics and the phenomena observed in Autistic subjects.” Instead, the authors demonstrate how experience, language, and personal relationships fundamentally shape human development through brain plasticity mechanisms that continue throughout life.

The Psychoanalytic Alternative to Behavioral Models

The Problem With Behavioral Suppression

Mainstream autism treatment, particularly ABA, focuses on suppressing observable symptoms through reinforcement protocols. This approach fundamentally reduces Autistic individuals to their behaviors, treating symptoms as deficits to be corrected rather than meaningful productions. When Autistic subjects are forced to conform to social ideals through behavioral modification—suppressing their “strange” interests, controlling Facial expressions, abandoning repetitive behaviors—the result is “the annihilation of the subjective dimension and a kind of subjective silence.”

Paradoxically, this creates “a different kind of autism” rather than healing. The rigidity of behavioral methods is presented as incompatible with respecting autistic subjectivity, as these approaches require little training and discourage meaningful relationships through their emphasis on one-to-one protocols that prevent genuine transference and engagement.

The Lacanian Understanding: Autism As Foreclosure

From a Lacanian perspective, autism involves a specific failure in symbolic structure where the “Name-of-the-Father” (the paternal metaphor that organizes the symbolic order) is foreclosed. Unlike Psychosis, where the subject remains “petrified” under a single signifier, autism involves resistance to signifying alienation itself—the Autistic subject remains on the edge of or refuses to be fully caught by the signifying chain.

This foreclosure prevents the normal separation and division that allows access to discourse. The subject experiences the Other as non-barred (complete), meaning no object has been removed from the Other’s body through the symbolic cut; consequently, the circuit of the drive cannot properly establish. The living being remains “submerged in a real of pure and undifferentiated jouissance” (excessive enjoyment/suffering).

Language and the Subject of Enunciation

Autistic individuals are not outside language but maintain a particular, often problematic relationship to it. Many Autistic children are Verbal, but their speech is characteristically marked by echolalia (repetitive echoing of words), disconnection from emotional resonance (the voice lacks affect and expressiveness), and a loss of semantic value—words remain “unmoored from things.”

The autist often refuses to become alienated in the Other’s language, viewing it as intrusive and persecutory. Some autists find language via Writing or online communication easier because these exclude “the jouissance of the voice”—the voice, gaze, and touch are experienced as signs of the Other’s dangerous existence rather than as communicative tools.

The fundamental issue is the Autistic subject’s foreclosure of “lalangue”—the material basis of language and the first modality of human discourse typically established through motherese (baby talk) that mother and infant co-create. Without this foundation, the deictic function of speech (anchoring meaning to the speaker’s subjective position) remains severely compromised.

Autism As Subjective Defensive Position

The Border (le Bord) and Defensive Structures

To manage the foreclosure of the Name-of-the-Father and the absence of the signifying cut, Autistic individuals construct defensive boundaries—what theorists call “le bord” (the edge/border). Within this boundary, the autist feels safe; outside it exists chaos and the engulfing void of infinite jouissance.

This border is maintained through three interweaving elements:

The double (a hallucinated or concrete other the subject can control)
The autistic object (a concrete object providing containment)
An area of competence or obsessive fixation

The autist’s experience of the Other’s existence—through gaze, voice, touch, desire, will, or orders—represents radical threat because the normal symbolic cut has not separated the subject from the Other’s jouissance.

The Body As Fortress

Importantly, the body of Autistic children appears mechanically disaffected: stiff or robotic gait (often tiptoeing and leaning forward), repetitive movements, sometimes severe Self-injurious behavior. These are not simply Neurological symptoms but manifestations of the body’s non-inscription by the signifier. The body functions as a “fortress” or “armour” protecting the subject from contact with others.

Notably, functions mediated by the Other’s demand—those requiring symbolic entry (like toileting, responding to gaze, using voice meaningfully)—become problematic, while purely organic functions remain intact.

The Fragility of Rigidity

The autist’s rigidity and immutability are not pathology but precarious defense: the autist’s apparent rigidity maintains a fragile pseudo-Borromean knot; any disruption threatens to unfold it into void. Repetitive behaviors, need for sameness, and obsessive fixations function as stabilizing “buckles.” Forcing flexibility or spontaneity destabilizes the entire structure, triggering panic, perplexity, or violent decompensation.

For this reason, Temple Grandin’s “squeeze machine” exemplifies how a stabilizing double—whether concrete (the machine), hallucinated, or animal-based (identification with cows)—can anchor subjective consistency and enable meaningful activity while the subject remains in a frozen, two-dimensional space lacking normal social mobility.

Brain Plasticity and the Limits of Biological Determinism

Experience-Driven Development

Neuroscience research demonstrates that brain structure and function are fundamentally shaped by experience, language, and personal history rather than determined solely by genetics. Crucially, 90% of synaptic connections in the adult brain (estimated at one million billion synapses) are constructed over time through experience, not genetically predetermined.

This neuroplasticity remains active throughout life:

Pianists develop thickened areas for finger dexterity and hearing
Taxi drivers develop enhanced spatial representation regions
Language itself physically shapes the developing nervous system through experience

The symbolic order—not biology alone—is the primary shaper of human development.

The Problem With Brain Imaging

MRI imaging, while useful, produces interpretations of data rather than direct images of brain activity—the signals detected are delayed by several minutes compared to actual neural firing (thousandths of a second). This interpretive gap is frequently overlooked in popular presentations.

Scientism promotes normative standards that leave deviating subjects open to Stigma. The current scenario of purely biological explanation cannot be understood without considering market forces: “Autism today is big business,” with coalescence of new treatments favoring pharmaceutical and biological frameworks that generate profitable diagnoses and interventions.

Neoliberal Commodification and Diagnostic Expansion

Autism As Product

Under neoliberalism, autism has become “a kind of product, sold in a growing number of copies to state authorities expected to treat it and to private funders asked to charitably Support it.” Prevalence rates have expanded dramatically from 0.05% (1966-1976) to 1-3% of the population in contemporary research through diagnostic expansion.

This expansion reflects not only increased awareness but also methodological reduction: clustering diverse conditions under “autism” and applying standardized treatments. Simultaneously, this expansion generated profitable markets for behavioral interventions and disability compensation rather than treatment.

The Performance Metrics Problem

The state now issues “scientific laws” as policy, reflecting the infiltration of market logic into public services. Public opinion, mediated by media dramatization of parental suffering, increasingly dictates medical and educational policy rather than rigorous scientific inquiry. “Compassion”—immediate individual identification with victims—has replaced social solidarity and collective responsibility.

This atomizes society into competing microenterprises, including patients as “consumers of services” who choose between competing therapeutic offerings. Performance metrics become more important than actual clinical work; evaluation of measurable behavioral outcomes supersedes understanding meaning or facilitating growth.

Why Aba Dominates Markets

ABA’s simplicity, low training requirements, and measurable outcomes make it ideal for neoliberal markets, while psychoanalytic approaches—requiring patience, creativity, long-term investment, and attention to subjective complexity—cannot compete in this framework.

The DSM-III (1980) shifted to criteria-based, a-theoretical classification excluding psychopathology, and autism became classified as a developmental disability rather than a disease, providing access to education funding rather than healthcare. This administrative classification perfectly aligned with cost-cutting logic: it is cheaper to compensate disability financially than to invest in reducing handicap.

Historical Context: from Psychoanalytic Understanding to Neoliberal Management

Early Psychoanalytic Approaches

Jacques Hochmann’s historical analysis traces how autism was initially approached through psychoanalytic and psychodynamic lenses by figures like Leo Kanner and Hans Asperger, who viewed symptoms as meaningful adaptations rather than mere deficits.

Post-WWII France and Europe developed sophisticated systems combining psychiatric, educational, and therapeutic approaches in reformed institutions emphasizing human dignity and individual development.

Institutional Models

Institutions like Bonneuil-sur-Marne (founded by Maud Mannoni in 1969) and Belgian centers like Le Courtil and Antenne 110 modeled approaches based on understanding “what the logic at stake is for each child” and using it to help construct a subjective position.

The Neoliberal Turn

This changed dramatically with the neoliberal revolution beginning in the 1980s. Ronald Reagan’s suspension of federal funding eliminated the community mental health programs modeled on the French “sector” system.

Parent advocacy groups, dissatisfied with psychoanalytic approaches they felt blamed mothers, pushed for Neurodevelopmental models. While parental frustration with certain approaches was understandable, the movement toward exclusively biological frameworks eliminated nuanced understanding of the child’s subjective position and the parent-child relational dynamics that shaped development.

Autism As Heterogeneous Syndrome

The Problem with Standardized Diagnosis

Rather than viewing autism as a unified nosographic entity (like “autism” or “Autistic illness”), it should be understood as an “Autistic syndrome”—a set of symptoms arising from different etiologies.

Crucially, some cases represent an impediment (changeable obstacle) to entering symbolic alienation, while others involve an impossibility (fixed, real limitation). For impediments, the underlying structure might be Neurosis or psychosis that could eventually emerge. For impossibilities, the real constraints must be accepted as fixed.

Clinical Examples

For example, Child K presented with Autistic behaviors but revealed an ordinary neurotic structure once parental conflict resolved and relational work proceeded; he later read, wrote, and showed no Autistic signs by age six.

However, contemporary Diagnostic manuals reduce humans to behavior by identifying fixed, observable elements counted without considering functional meaning for that specific child. Tests often produce absurd situations: a child exploring a book’s tactile and auditory properties might be diagnosed as “cannot handle the book” because they didn’t inspect drawings conventionally, despite the child demonstrating creativity and engagement.

The Diagnostic Expansion Problem

The expansion of autism diagnoses from 4 per 10,000 (1966-1976) to 20 per 10,000 (post-2000) reflects methodological reduction accompanied by authoritarian discourse.

Approximately 80% of autism cases show no identifiable organic cause, yet the field routinely denies the role of “accidental encounters” and historical-signifying coordinates in the child’s development.

Early Intervention and Multidisciplinary Integration

The Importance of Early Support

Research demonstrates that individualized treatment beginning immediately after Diagnosis, accounting for the child’s bodily, sensory processing, cognitive, and psychic difficulties, can radically modify developmental trajectories.

Early intervention research by Italian researchers revealed that rather than cold, incompetent parents causing autism, certain babies were simply less responsive, gradually eroding parental confidence and competence. This shifted understanding: the problem lay in the closed circuit of drive between baby and caregiver.

Preaut Screening

Marie-Christine Laznik’s PREAUT screening identifies at-risk babies as early as four months by observing whether babies reach toward others, seek gaze, and offer themselves for shared pleasure—behaviors absent in at-risk infants.

Her interventions use “motherese” (melodious adult-to-baby speech) containing surprise and pleasure elements to “hook” withdrawn babies and reconnect the drive circuit. Such approaches work with both baby and parents, demonstrating that early, relational intervention can radically modify developmental trajectories.

Multidisciplinary Approach

An individualized treatment plan should combine psychoanalytic, behavioral, educational, and therapeutic modalities, requiring agreement between parents and clinicians with shared goals and mutual respect for colleagues’ approaches.

Psychoanalysis and behavioral approaches, while fundamentally different, may be complementary: synaptic transmission depends heavily on emotional experience, and early sensations create unique neuronal and psychic traces.

Practical Therapeutic Strategies

Affinity Therapy: Following the Child’s Passion

Affinity therapy is an ethics-based approach (not a rigid method) that follows the child’s lead by embracing their deep interests and passions. Originating from Ron Suskind’s account in Life, Animated (2014), the approach emerged when his Autistic son Owen used Disney movies—which he watched repetitively—to process complex social situations and find security.

Research at the University of Rennes 2 documents how Autistic individuals have used varied passions—Horseback riding, growing carnivorous plants, Tintin comics—to construct meaningful learning pathways.

Rather than dismissing fixations as obstacles, practitioners begin with the child exactly as they are, using the “privileged object” (a stick, thread, circuit, Disney character) as a starting point and inventing “different tools and strategies to extend and shift, expand this special centre of interest and slowly bring the child towards a process of learning.”

The Analyst’s “sideways” Position

The analyst working with Autistic subjects must adopt a “sideways presence” (être de biais)—positioned next to rather than face-to-face with the child, available but not imposing, respecting the child’s autonomy while refusing to disappear or become merely a tool.

The analyst must:

Avoid superego injunctions and prohibitions
Speak indirectly, avoiding simultaneous Eye contact and speech
Allow the child to guide the work
Respect the child’s persecution of the Other’s presence as real suffering
Use interpretation sparingly and tangentially, as “asides” rather than direct statements

Individualized Educational Integration

Rather than viewing psychoanalysis and behavioral/educational methods as antagonistic, effective Support combines them while maintaining ethical grounding in respect for Autistic subjectivity.

TEACCH, which adapts the environment to the person’s current capacities rather than forcing adaptation to an unadjusted environment, represents a more respectful educational model than rigid ABA. Incidental teaching through spontaneous activities and joint attention can be effective when practitioners recognize that every Autistic person requires different tools, mediation, and Support tailored to their specific Sensory dominance and psychic structure.

Understanding Reinforcement

When behavioral techniques are employed, reinforcement must follow behavior within moments to be effective; delayed reinforcement loses impact. However, practitioners must carefully choose reinforcements, as poorly chosen reinforcements—those allowing task avoidance—teach children that inappropriate behavior produces desired escape, creating counterproductive cycles.

The trainer’s ultimate goal is to eliminate reinforcement entirely once the pleasure of success or wellbeing becomes intrinsically motivating, requiring the Autistic person to understand contingency (cause-and-effect relationships).

Clinical Outcomes and Transformation

What Change Looks Like

Treatment aims at reducing anxiety and suffering imposed by the Autistic position, helping subjects live with dignity and respect—not at suppressing autism or forcing normality. This progress is not “staturable”—the number of times someone says “good morning” reveals nothing about anxiety management.

The source of change locates on the Autistic subject’s side; it stimulates and accompanies dynamics of change inherent in the child. Solutions are always unique; children must be accompanied in their work of invention beyond social ideals and norms.

Meaningful Clinical Change

Clinical examples demonstrate significant change:

Patient B, treated from age four to eighteen, developed from complete logorrhea consisting entirely of television commercials to extraordinary memory for facts, learning social formulas, obtaining reliable employment, learning music competently, and expressing limited genuine desire
Patient P developed significant artistic talent through analytic work
Patient M achieved partial insertion in discourse as subject of enunciation

This represents not failure but remarkable human possibility—the difference between a person living in torment and a person living bearably with agency and some capacity for authentic connection.

Critical Considerations and Warnings

Risk of Subjective Harm

The book documents significant risk of psychological harm from behavioral interventions applied without recognition of Autistic subjectivity. Early ABA developers (Ole Ivar Lovaas) used electroshocks as punishment; contemporary ABA, while typically less violent, maintains the fundamental logic of treating Autistic individuals as objects to be shaped.

Autistic individuals report that behavioral protocols deepen their “already serious problems of identification and humanization” and “abolishes the very essence of our reason for existence.”

The Danger of Diagnostic Expansion

The expansion of autism Diagnostic criteria has created a heterogeneous Diagnostic category concealing fundamentally different presentations. Without distinguishing between impediments and impossibilities, treatment recommendations become inappropriate.

The Limits of Biological Determinism

Despite media presentations suggesting Neurological causality is established, decades of research funding has failed to establish simple causal relationships between genetics and autism presentations. The insistence on biological causality despite lack of evidence represents ideological commitment rather than scientific rigor.

Professional Disagreement and Fragmented Care

When parents receive contradictory guidance from professionals—some emphasizing behavioral compliance, others emphasizing subjective recognition—they become paralyzed and unable to provide coherent Support.

References and Historical Context

Key Figures and Institutions

Françoise Dolto - Psychoanalyst emphasizing that “a child was a full-fledged person”
Marie-Dominique Amy - Psychoanalyst advocating “double reading” approach addressing both cognition and emotional experience
Catherine Vanier - Emphasizing that “if a child is not considered a small human subject, he will not be alright, even if he is hyper-well trained”
Pierre-Henri Castel - Sociologist analyzing French autism treatment debate

Autistic Voices

Temple Grandin - Autistic individual whose “squeeze machine” exemplifies stabilizing double function
Donna Williams - Autistic individual using hallucinated alter-ego Carol as stabilizing double
Annick Deshays - Autistic individual reporting harm from behaviorist approaches
Henry Bond - Autistic individual crediting both CBT and psychoanalysis

Historical Context

The book notes the problematic history that Hans Asperger—one of autism’s first describers—actively participated in Nazi Aktion T4 selection of children deemed unsuitable, sending them to clinics for experimentation and execution.

Contemporary Relevance and Future Directions

The Digitization Challenge

While technology didn’t create relationship difficulties, the prioritization of language code, loss of differentiation between speaking and writing through instant messaging, and growing discomfort with direct speech leave less space for the singular, for desire, and for surprise.

This increasingly technology-mediated communication may deepen isolation for individuals already struggling with authentic speech. However, some Autistic individuals find written communication—which excludes the persecutory jouissance of the voice—therapeutically valuable.

Moving Beyond Cure Models

Clinical change in autism is possible without radical cure and represents profound human transformation. Psychoanalytic treatment produces meaningful change in quality of life, subjective agency, and capacity for connection without “curing” autism or eliminating its fundamental structure.